Provider Demographics
NPI:1871854703
Name:SYSTEM 4 LIVING WELL
Entity Type:Organization
Organization Name:SYSTEM 4 LIVING WELL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:DEXTER
Authorized Official - Middle Name:
Authorized Official - Last Name:HOLMES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:732-640-7107
Mailing Address - Street 1:16 BRISTOL RD
Mailing Address - Street 2:
Mailing Address - City:PISCATAWAY
Mailing Address - State:NJ
Mailing Address - Zip Code:08854-3610
Mailing Address - Country:US
Mailing Address - Phone:732-640-7107
Mailing Address - Fax:866-421-9357
Practice Address - Street 1:16 BRISTOL RD
Practice Address - Street 2:
Practice Address - City:PISCATAWAY
Practice Address - State:NJ
Practice Address - Zip Code:08854-3610
Practice Address - Country:US
Practice Address - Phone:732-640-7107
Practice Address - Fax:866-421-9357
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-06-07
Last Update Date:2012-07-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Multi-Specialty